Clinical profile and association of Celiac Disease in children with type-1 Diabetes Mellitus

Main Article Content

Dilawar Khan Jokhio
Versha Rani Rai
Shazia Mahar
Roshia Parveen
Uzma Salman
Mohsina Noor Ibrahim

Abstract

OBJECTIVE: To find out the clinical profile and association of Celiac Disease (CD) in children with established type-1 Diabetes Mellitus (T1DM) presenting in a tertiary care hospital of Karachi, Pakistan.


METHODS:  This cross-sectional study was conducted from January-2019 to July-2019 at National Institute of Child Health, Karachi, Pakistan. A total of 126 T1DM patients of age 1-18 years were subjected to detailed history and clinical examination for CD except those in diabetic ketoacidosis and having pancreatic calcifications. Blood sample was drawn from the patients for Tissue Transglutaminase (tTg) Immunoglobulin A (IgA) and tTg Immunoglobulin G (IgG) levels and Anti-Deamidated Gliadin Peptide (anti-DGP) IgG was estimated using commercially available Enzyme Linked Immunosorbant Assay.


RESULTS:    Twenty-nine (23.0%) patients were diagnosed as CD based on positive serology. The mean age of the patients was 9.31±4.40 years, 70 (55.6%) were male and 56 (44.4%) patients were female. Out of 126 T1DM patients, 29 (23.0%) were diagnosed with CD. Raised anti-DGP IgG levels were observed in 39 (30.95%) patients, raised anti-tTg-IgA levels in 35 (27.78%) and raised Anti-tTg IgG level in 36 (28.57%) cases. Other associated features included anemia (n=85; 67.46%), vomiting (n=50; 39.6%), abdominal distension (n=37; 29.3%), diarrhea (n=30; 23.81%) and abdominal pain (n=26; 20.6%).


CONCLUSION: CD is relatively common in children with T1DM, affecting both genders. Specific serological markers proved significant in CD identification. This study highlights associated features like anemia and gastrointestinal symptoms, emphasizing the need for careful consideration of CD in T1DM patients.

Article Details

How to Cite
Jokhio, Dilawar Khan, et al. “Clinical Profile and Association of Celiac Disease in Children With Type-1 Diabetes Mellitus”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 15, no. 2, June 2023, pp. 91-5, doi:10.35845/kmuj.2023.22750.
Section
Original Articles

References

Hashmi MA, Hussain T, Masood N, Asghar RM. Diarrheal versus non-diarrheal presentations of Paediatric Celiac Disease. J Coll Physicians Surg Pak 2016;26(8):662-6.

Jamila RAK, Ahmed I, Yousafzai JK, Mehmood W, Khan SA, Ahmad W, et al. Celiac Disease in different age groups and gender in Pakistan. J Rawalpindi Med Coll 2018;22(3):244-7.

Durham J, Temples HS. Celiac Disease in the pediatric population. J Pediatr Health Care 2018;32(6):627-31. https://doi.org/10.1016/j.pedhc.2018.04.023

Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, et al. Celiac Disease: From pathophysiology to treatment. World J Gastrointet Pathophysiol 2017;8(2):27. http://dx.doi.org/10.4291/wjgp.v8.i2.27

Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig MEJP. Screening for Celiac Disease in Type-1 diabetes: a systematic review. Pediatrics 2015;136(1): e170-e6. https://doi.org/10.1542/peds.2014-2883

Dayal D, Hegde A. Metabolism. Prevalence of islet autoantibodies in Type-1 diabetes. Indian J Endocrinol Metab 2017;21(3):485-6. https://doi.org/10.4103/ijem.IJEM_24_17

Serena G, Camhi S, Sturgeon C, Yan S, Fasano A. the role of gluten in Celiac Disease and Type-1 diabetes. Nutrients 2015;7(9):7143-62. https://doi.org/10.3390%2Fnu7095329

Adlercreutz EH, Svensson J, Hansen D, Buschard K, Lernmark Å, Mortensen HB, et al. Prevalence of Celiac Disease autoimmunity in children with Type-1 diabetes: regional variations across the Øresund strait between Denmark and southernmost Sweden. Pediatr Diabetes 2015;16(7):504-9. https://doi.org/10.1111/pedi.12200

Joshi R, Madvariya MJ. Prevalence and clinical profile of Celiac Disease in children with Type-1 Diabetes Mellitus. Indian J Endocrinol Metab 2015;19(6):797. https://doi.org/10.4103/2230-8210.167555

Bybrant MC, Grahnquist L, Örtqvist E, Andersson C, Forsander G, Larsson HE, et al. Tissue Transglutaminase autoantibodies in children with newly diagnosed Type-1 diabetes are related to human leukocyte antigen but not to islet autoantibodies: a Swedish nationwide prospective population-based cohort study. Autoimmunity 2018;51(5):221-7. https://doi.org/10.1080/08916934.2018.1494160

Lebwohl B, Sanders DS, Green PH. Coeliac disease. The Lancet 2018;391(10115):70-81. https://doi.org/10.1016/S0140-6736(17)31796-8

Bartoloni E, Bistoni O, Alunno A, Cavagna L, Nalotto L, Baldini C, et al. Celiac Disease prevalence is increased in primary sjögren’s syndrome and diffuse systemic sclerosis: lessons from a large multi-center study. J Clin Med 2019;8(4):540. https://doi.org/10.3390/jcm8040540

Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of Celiac Disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018;16(6):823-36. e2. https://doi.org/10.1016/j.cgh.2017.06.037

Jalilian M, Jalali RJD. Prevalence of Celiac Disease in children with Type-1 diabetes: A review. Diabetes Metab Syndr 2021;15(3):969-74. https://doi.org/10.1016/j.dsx.2021.04.023c

Sahin Y, Cakir MD, Isakoca M, Sahin DAJIJoP. Prevalence of Celiac Disease in children with Type-1 Diabetes Mellitus in the South of turkey. 2020;30(1). https://doi.org/10.5812/ijp.97306

Du YT, Rayner CK, Jones KL, Talley NJ, Horowitz M. Gastrointestinal symptoms in diabetes: prevalence, assessment, pathogenesis, and management. Diabetes Care 2018;41(3):627-37. https://doi.org/10.2337/dc17-1536

Aygun C, Uraz S, Damci T, Osar Z, Yumuk V, Akdenizli E, et al. Celiac Disease in an adult Turkish population with Type-1 Diabetes Mellitus. Digestive Dis Sci 2005;50:1462-6.

Abd El Dayerm SM, Aly AA, Abd El Gafar E, Kamel H. Original research Screening for coeliac disease among Egyptian children. Arch Med Sci 2010;6(2):226-35. https://doi.org/10.5114/aoms.2010.13900

Sansotta N, Amirikian K, Guandalini S, Jericho H. Celiac Disease symptom resolution: effectiveness of the gluten-free diet. J Pediatr Gastroenterol Nutr 2018;66(1):48-52. https://doi.org/10.1097/MPG.0000000000001634

Mahmood N, Malik U, Hameed M, Firdous S, Masood S, Munir S, et al. Presence of Celiac Disease in Type-1 Diabetic Patients Presenting at Jinnah Hospital, Lahore. Ann King Edward Med Univ 2017;23(3). https://doi.org/10.21649/akemu.v23i3.2032

Nejad MR, Rostami K, Pourhoseingholi MA, Mojarad EN, Habibi M, Dabiri H, et al. Atypical presentation is dominant and typical for coeliac disease. J Gastrointestin Liv Dis 2009;18(3):285-91.

Similar Articles

1 > >> 

You may also start an advanced similarity search for this article.